宫腔镜术后发生相关并发症危险因素分析及预防对策

Analysis of risk factors of complications after hysteroscopy and preventive measures

目的探讨分析宫腔镜术后发生相关并发症危险因素分析及预防对策。方法收集2015年1月1日—2017年12月31日在我院进行宫腔镜操作且资料齐全的2843例病例资料,包括姓名、年龄、身高、体重、月经状态、手术类型、生育史、剖宫产史、刮宫史、盆腔炎病史等相关信息,观察患者术后发生的子宫穿孔、感染、液体过度负荷综合征(TURP综合征)、大出血、空气栓塞等并发症的发生情况。结果 2700例宫腔镜检查均未见明显手术并发症。143例宫腔镜手术中,12例出现术后并发症,发生率为8.39%,其中子宫穿孔4例(2.80%),出血2例(1.40%),TURP综合征4例(2.80%),感染2例(1.40%)。并发症组患者剖宫产史、刮宫史、盆腔炎病史的发生率皆明显高于无并发症组(P<0.05)。结论宫腔镜术后发生相关并发症的危险因素为剖宫产史、刮宫史、盆腔炎病史,应当详细告知手术风险,严格无菌操作,加强术中监护、谨慎操作及术后护理,尽量缩短手术时间,必要时使用抗生素预防感染,从而减少术后并发症发生。

Objective： To investigate and analyze the risk factors of complications associated with hysteroscopy. Methods： to collect 2843 cases of hysteroscopic operation and complete data in our hospital in December 31 st-2017 January 1,2015,including name,age,height,weight,menstruation,operation type,birth history,and cesarean section. The history of curettage,the history of pelvic inflammation and other related information,the incidence of complications such as uterine perforation,infection,fluid overloading syndrome（ TURP syndrome）,massive hemorrhage,air embolism,and so on. Results： 2700 cases of hysteroscopy. Of 143 cases of hysteroscopic surgery,12 cases（ 8. 39%） had postoperative complications,including uterine perforation in 4 cases（ 2. 80）,hemorrhage in 2 cases（ 1. 40%）,TURP syndrome in 4 cases（ 2. 80%） and infection in 2 cases（ 1. 40%）. The incidence of cesarean section history,curettage history and pelvic inflammatory disease history in the complications group were significantly higher than those in the non-complication group（ P〈 0. 05）. Conclusion： the risk factors of complications after hysteroscopy are history of cesarean section,history of curettage and history of pelvic inflammatory disease. Intraoperative monitoring,careful operation and postoperative care,shorten the operation time as far as possible,and use antibiotics to prevent infection when necessary,so as to reduce postoperative complications.